- In patients with advanced ovarian cancer, neoadjuvant chemotherapy followed by interval cytoreductive surgery (NACT+ICS) is associated with lower morbidity and mortality and higher complete cytoreduction rates vs primary cytoreductive surgery (PCS), but no survival advantage.
Why this matters
- PCS remains standard of care in this setting.
- NACT+ICS can be an acceptable alternative in select patients with comorbidities, high frailty, and increased tumor burden.
- A meta-analysis of 17 studies including 3759 patients with advanced ovarian cancer who underwent PCS or NACT+ICS.
- Funding: None.
- Patients in the NACT+ICS vs PCS group had significantly less:
- Operative time (mean difference [MD], −35 minutes; P=.01).
- Intraoperative blood loss (MD, −382 mL; P<.001>
- Average length of hospital stay (MD, −5.0 days; P=.002).
- Optimal cytoreduction rates (71.3% vs 59.8%; OR, 1.9; P=.001).
- Complete cytoreduction rates (44.4% vs 28.3%; OR, 2.2; P=.0001).
- Clavien-Dindo grade ≥3 morbidity (21.2 % vs 8.8%; P<.0001>
- 30-day mortality rate (OR, 6.1; P=.0008).
- Bowel resection rate (23.5% vs 8.8%; OR, 3.2; P<.001>
- Heterogeneity across studies.
- Lack of QoL data.